The Achiness Of The Long Distance Runner

This is Strength in Numbers, a new column exploring the science of sports and athleticism. As this feature takes shape, I welcome your feedback, suggestions and news tips. Email me, leave suggestions in the comments section or tweet to me @CragCrest.

Elite marathoners run through the pain

Running can hurt. On Monday at the Boston Marathon, the defending women’s champion, Kenya’s Caroline Rotich, dropped out after five miles with an ankle injury. It’s unlikely she was the only runner trying to push through. A new study of elite distance runners suggests that a lot of top runners run with aches and pains. The study surveyed 199 elite marathoners and found that 75 percent of them reported musculoskeletal pain in the last 12 months. The most common sites of nagging pain were the lower leg (19.1 percent), knee (15.3 percent), Achilles tendon (14.5 percent) and the thigh (12.8 percent). More than a third of the runners reported pain in two distinct locations, while 15.3 percent had three painful sites.

These numbers are nearly four times higher than the ones reported in a 2011 study that assessed musculoskeletal pain in recreational runners. That study gathered data from 1,049 runners at five races in São Paulo, Brazil, and found that prevalence of pain ranged from 20 percent among the 796 male respondents and 27 percent among the 253 female participants.

But the true numbers could be higher among average runners. A systematic review of the literature published in 2007 found that rates of lower-extremity running injuries ranged from 20 to 79 percent. The review also found that the knee was the most common site of pain, but aches in the shin, Achilles tendon, calf, heel, foot and upper leg were also common. High mileage was one risk factor for injuries, which might explain why they’re so common in elites. The more you run, the more of a pain it is, apparently.

Masters of cheating

A lot of my non-athlete friends have sent me this recent New York Times story chronicling the story of Julie Miller, a masters class triathlete from British Columbia caught cutting the course at last year’s Ironman Canada. Why, they asked, would someone resort to cheating to win a 40+ age group award? That’s a question journalist Peter Flax ponders in a CyclingTips story about Michael Buckley, a 41-year-old cyclist from Reno who just received a four-year racing ban from the U.S. Anti-Doping Agency after testing positive for multiple performance-enhancing drugs. Flax doesn’t find an easy answer. “People blog and tweet like [doping] takes place in black and white but the reality is messy, where the lines between good and bad are porous,” he writes. “Who among us has not cheated at some element of life?”

Apparently, some Boston Marathoners are nodding their heads in agreement. Runner’s World reports that increasingly stringent qualification standards in Boston have led some runners to obtain a race bib by bending the rules — falsifying race results, running with someone else’s bib, asking a faster runner to run under their name for a qualification time, or even cutting the course. Meanwhile, a 45-year-old business analyst in Cincinnati named Derek Murphy has made a hobby out of investigating allegations of cheating and outing the perpetrators. Have you got a course cutter or bib swapper to report? Send your suspicions here.

Signs of brain injury in retired NFL players

As I’ve written before, there’s still a lot we don’t know about the link between concussions, football and chronic traumatic encephalopathy. One of the things holding us back: a lack of rigorous longitudinal studies that quantify how much head trauma players experience and what happens to them in the following years or decades. To get those, we need a way to monitor what’s happening in the brain before it can be sliced open for examination.

Now researchers are looking into the brains of the living using a kind of MRI called diffusion tensor imaging, which allows them to see the flow of water through the brain’s white matter, which is susceptible to trauma. On Tuesday at the American Academy of Neurology annual meeting in Vancouver, Florida State University neurologist Francis Conidi and his colleagues are sharing results from a preliminary study finding that 17 of the 40 retired NFL players who were tested had signs of traumatic brain injury.

Exactly what that means is hard to interpret. It’s a sign that the players have experienced an injury to the brain, but is it evidence that these players are destined to develop CTE? Not necessarily, Conidi said. “It could be that this is traumatic brain injury and they’re never going to get worse,” Conidi told me. “Everybody’s coming in here thinking they have CTE,” and worrying that by the time they’re 55 they’re going to be like Mike Webster — the former Pittsburgh Steelers center who died in 2002 — not able to remember what he was talking about in a conversation. “I tell them, listen — this might be as bad as it gets. We can rehabilitate them,” Conidi said. It’s not always clear which brain injuries can heal or be overcome and which will be lasting, but researchers have developed methods for rehabilitating people with mild traumatic brain injuries.

Conidi’s group has close to 100 former NFL players now enrolled in the study, but “it’s a skewed population,” he said, because they’re players who’ve come to him out of concern that something could be wrong. To figure out what symptoms and changes in the brain are indicative of a degenerative neurological problem and which are indicative of injuries that might heal or at least not get worse, we need a way to monitor changes in the brain over time. This preliminary study is only a piece of the puzzle, but the imaging technique the researchers are using shows potential. Since we can’t cut people’s heads open to see what’s going on after a concussion, we need to develop imaging techniques that can show changes in the brain, and DTI seems like a promising tool, said Chad Asplund, director of athletic medicine at Georgia Southern University.

Vitamin I strikes out again

Athletes sometimes refer to ibuprofen as “vitamin I,” because so many of them pop it before or after workouts in hopes of reducing inflammation and decreasing soreness and pain. But a new study found that ibuprofen did not reduce blood markers of muscle damage or subjective muscle soreness after a hard weight training session. It was a small study, just 16 participants, but it’s not the first to suggest that ibuprofen doesn’t blunt post-exercise muscle soreness. A previous study of ibuprofen use in ultramarathon runners found that the drug failed to reduce muscle pain or soreness, and blood tests showed that runners who took it actually experienced greater levels of inflammation than those who eschewed the drug.

If that’s not convincing reason for exercisers to lay off the pills, consider that mixing a nonsteroidal anti-inflammatory like ibuprofen with intense exercise and dehydration can tax your kidneys and increase the risk of rhabdomyolysis, a precursor to kidney failure. There’s a final reason to skip the NSAIDs if you’re in the midst of a hard training block — inflammation is part of the adaptation process, and dampening it could blunt the training effect.

Finally, a different kind of sports science:

Christie Aschwanden is FiveThirtyEight’s lead writer for science. Her book “Good to Go: What the Athlete in All of Us Can Learn from the Strange Science of Recovery” is available here. @cragcrest